NURS 6560 WALDEN UNIVERSITY EXIT EXAM
1. You see a 73-year-old woman with a 40 pack year smoking history, chronic obstruction pulmonary disease and
... [Show More] peripheral artery disease who presents with an ulcer on the soul of her left foot. The also has an irregular edge and pale face and punched out appearance, with the surrounding skin white and shiny. The patient states that the pain is worse at night in bed and when the legs are elevated. The most likely diagnosis is:
-arterial ulcer
2. Hey 75-year-old man presents with chief complaints of headache, Nausea, and muscle weakness. His creatinine level is 2.1 MG/DLNGFR is 30 ML/MIN/1.73 m2. He currently takes a thiazides diuretic for the management of hypertension. Which of the following statements is false regarding the use of diuretics in the elderly?
-loop diuretics are contraindicated when GFR is <40 ml/min/1.73 m2
3. All of the following practices are recommended when prescribing medication with confusing or similar-sounding names except:
- including either the generic or brand name on the prescription order, but not both
4. A 19-year-old is diagnosed with meningococcal meningitis. In order to prevent secondary infections among adults who had close contact with the patient, all of the following are recommended except:
- Prophylaxis with acyclovir (Zovirax)
5. A 38-year-old woman comes to the emergency department complaining of a rapid heartbeat, tremors, and chest tightness. She reports early in the day she was feeling a migraine starting so she took a pill giving to her by her friend who also experience migraines. Her medical history reveals that she is currently taking a monoamine oxidase inhibitor for depression. Which migraine medication did see most likely take?
-Almotriptan ( alert)
6. 826-year-old woman presents with uncomplicated UTI. She is otherwise healthy, has not received any systematic anti microbials in the past year and it’s not taking any medications. She is currently not pregnant and is using etonogestrel/ estradiol vaginal ring for contraception. The local E. Coli resistance rate to TMP/SMX is about 12%. The preferred therapy for this patient is:
- Trimethoprim-sulfamethoxazole
7. As part of the Deficit reduction act of 2005, Medicare will incorporate quality payment adjustments for certain hospitals-acquired conditions, including all of the following except:
-Myocardial ischemic
8. Which of the following example describes a potential malpractice scenario?
-A post-myocardial infraction patient is prescribed an inappropriate dose clopidogrel and experience a severe blessing episode.
9. A 57-year-old woman presents for a flu shot as she has heard reports that it will be “a bad flu season’. She has had no primary care for more than 10 years she like health insurance. She admits to a 30 pack here cigarette smoking history, currently smoking one pack for a day. Her history and examination are unremarkable. Which screening test would you recommend?
- Mammography
10. A 28-year-old woman presents who complains of tugging chest pain unrelated to physical activity. She is generally in good health and non-smoker has a BMI of 23 KG/M2, and denies dyspnea of dizziness. Physical examination reveals a grade 2/6 late systolic murmur that follows a midsystoloc click at the 5th intercostal space, mid-clavicular line. An echocardiogram Fails to reveal mitral valve tissue redundancy. This can you go presentation is most consistent with:
- Mitral Valve prolapse
11. A quality improvement plan characterized by Limiting variability and removing defects in a process best describes:
- six sigma
12. Laboratory findings of a 28-year-old male suspected of a heart stroke can include all of the following except:
- Hypermatremia
13. A 42-year-old male presents with a sudden onset of inability to tightly close the eye lid, frown, or smile on the right side. His examination is otherwise unremarkable and past medical history is unremarkable. This likely represent paralysis of cranial nerve:
- VII
14. You see a 71-year-old man with atrial fibrillation and chronic obstructive pulmonary Disease who is diagnosed with community-acquired Pneumonia. His medical history does not show any drug allergies and he completed a course of respiratory fluoroquindore for the treatment of acute bacterial sinuses within the past month. Which of the following would you consider The most appropriate choice of anti-microbial?
-High dose amoxicillin
15. According to the Consolidated Omnibus Reconciliation Act ( CORBA), The spouse of an eligible employee will be eligible for COBRA coverage in all of the following circumstances except when the eligible employee:
- is terminated for misconduct
16. A 43-year-old woman presents in the emergency department with a chief complaint of swelling of the ankles, hands, and face. She also reports urine dad is darkly colored and foamy. Her blood pressure is 184/118 mm hg. All of the following urinalysis findings will support a diagnosis of glomerulonephritis except:
- Elevated levels of ketones
17. A 78-year-old male is being treated for hypoglycemia episode. He has a long history of type 2 diabetes mellitus as well as congestive heart failure and COPD. He is currently taking basal insulin with a sulfonylurea. What is the acceptable a A1C goal for this patient?
- <8%
18. Tertiary Prevention activities for a 69-year-old woman with congestive heart failure and type 2 diabetes mellitus include:
- Adjusting therapy to minimize dyspnea
19. A physicians employs an NP to provide service at a satellite acute care clinic. If the physician is never present at the clinic, which of the following statements is true?
- The NP services should be billed under the NP’s provider number.
20. You see a 48-year-old man with a chief complaint of pain during urination. Imaging reveals the presence of a kidney stone in the ureter. Do you consider all of the following management option except:
- Thiazides diuretic use
21. In managing a 58-year-old woman who is admitted for deep vein thrombosis, caution should be used with which of the following medication due to risk of heparin induced thrombocytopenia?
- Enoxaparin (lovenox)
22. You see a 76-year-old woman living at home who is accompanied by her home care provider. She has COPD and type two diabetes mellitus. An example of a secondary prevention strategy is:
- Checking her blood pressure
23. All of the following persons are eligible for Medicare service except:
- A 69-year-old undocumented resident in the US with atrial fibrillation
24. The NP is called to treat a 43-year-old woman for multiple contusions following a domestic violence attack. The NP realizes that one of the best predictors of a subsequent homicide of victims are domestic violence is:
- History of perpetrator attempting to strangle the victim
25. When initiating therapy for a spironolactone for a patient who Is also and ace inhibitor, you advise the patient to return in 5 days to check which of the following laboratory parameters?
- Potassium
26. All of the following are examples of primary prevention strategies except:
- performing a hemoglobin A1C for all patients admitted to the hospital
27. When considering HIPAA regulations, all the following are examples of” individual identifiable health information” except:
- The number of prescriptions of oxycodone written each month by a provider
28. Which of the following statements is false regarding end-of-life decisions making for a patient that is hopelessly and terminally ill?
- Advance directives are legally binding and recognized in all 50 states
29. While evaluating 833 or female with a two day history of dysuria, which of the following findings in urinalysis is most suggestive of urinary tract infection caused by a gram-negative organism?
- Nitrites
30. You are examining a 65-year-old woman with a history of rheumatic heart disease. In assessing the patient for mitral stenosis, you expect to find a heart heart murmur characterized as:
-localized low-pitch late diastolic heard best at apex.
31. The privacy rule established by the US health department and human services in 1996 Implemented the requirements for:
- Health insurance portability and accountability act (HIPPA)
32. When managing elderly patients with diminish cognitive function, which of the following statements is true regarding patient’s competence for making in form healthcare decisions?
- only a court can appoint a guardian to make decisions for a patient declared incompetent
33. A 17-year-old male is admitted after experiencing sudden, severe pain in the scrotum during the night. Physical examination reveals swelling of the scrotum and the loss of cremasteric reflex. His heart rate is 110 bpm, Blood pressure 150/80 mm hg, and temperature 99.8 F. There’s most likely represents:
- testicular torsion
34. In considering treatment for Jane in the previous question, which of the following would be most appropriate if she has a history of penicillin allergy?
- amoxicillin
35. All of the following are required Medicare terms and conditions for paying NP service except:
- separate charges are billed for NP services and facility charges
36. The NP is called to evaluate a 57-year-old man who reports episodes of acute angina with physical exertion. He is currently taking an ace inhibitor and low-dose aspirin. The NP considers which of the following approaches at the start of anginal symptoms?
- A dose of nitroglycerin via sublingual spray
37. A 41-year-old woman is diagnosed with hypertension that requires medication. She is otherwise healthy but currently takes drospirenone/ethinyl estradiol for birth control. Which of the following antihypertensive medication would be least preferred for this patient?
- Calcium channel blocker
38. The NP is called to evaluate Jane, a 43-year-old woman, who presents with a diffuse maculopapular rash that began on The trunk but now covers the entire body, including the palms and soles. The rash is not itchy but wart-like sores are present in the mouth and genital area as well as skin folds. Initial evaluation reveals generalize lymphadenopathy And a low-grade fever, and she complains of lethargy and headache. The patient reports that she had a painless genital ulcer that healed on its own about 3 weeks earlier. Which of the following is the most likely diagnosis?
- Genital Herpes
39. Gary is a 63-year-old African-American male who has been treated for hypertension with ace inhibitors her monotherapy for the past six weeks. Despite carries insistence that he is taking his medication as directed, his blood pressure continues to elevated. Gary mentions that he prefers not having to take multiple medications is day due to the cost and convenience. Which of the following is the most appropriate course of action?
- switch to a calcium channel blocker
40. A 15-year-old male is brought into the emergency department by his parents following a 12 hour history of nausea, family, and abdominal pain. Physical examination reveals obturator and psoas signs and a temperature of 102.6 F. Anticipated white blood cell with differential results are as follows:
- Total WBC = 16,500/ mm3, Neutrophils=66%, Bands=8%, Lymphocytes=22%
41. A 27-year-old man presents with a chief concern of an abnormal mass within his left scrotum. He describes it as feeling like a bag of worms in his present when he is standing but disappears when he lies down. His past medical history is unremarkable and his BMI is 29 KG/M2. He has been in a monogamous relationship for the past four months. The most likely diagnosis is:
- Varicocele
42. In a patient diagnosed with infections mononucleosis, the use of amoxicillin should be avoided due to the risk:
- Rash
43. Mrs. Gonzalez is a 53 old female who is being evaluated for routine follow-up care. Her medical history includes dyslipidemia; hypertension, and rheumatoid arthritis. Laboratory animal is reveals elevated serum alanine transaminase and aspartate transaminase. The long-term use of which of the following medications is the most likely cause of this finding?
- Methotrexate
44. A 77 year old woman is accompanied by her husband for evaluation. She is currently being treated for metoprolol for hypertension and digoxin for atrial fibrillation. He reports that his wife is becoming increasingly forgetful over the past year, fell into note in Porten family events such as birthdays sometime to come and confused with driving directions to familiar locations. She has no previous psychiatric history. The most likely diagnosis is:
- Dementia
45. A 22-year-old college student presents with a two day history of severe sore throat and difficulty eating or drinking due to trouble swallowing. A physical examination reveals exudative pharyngitis and minimally tender anterior and posterior cervical lymphadenopathy. The NP suspects infectious mononucleosis and expects which are the following laboratory findings?
- Lymphocytosis with atypical lymphocytes
46. Phyllis is a 34-year-old woman who presents with a chief complaint of a migraine resulting in nausea and vomiting. She reports that she experiences multiple migraines each month. She has given a prescription for sumatriptan 100-mg tablets orally to treat acute migraine pain. When counseling Phyllis about the medication, the nurse practitioner advises about all of the following adverse effects except:
- Sedation
47. A 27-year-old woman is being evaluated for a seven day history of acute bacterial rhino-sinusitis. She is otherwise healthy and has not received any antimicrobial therapy in the past six months. She also has no history of drug allergy. In considering a first-line antimicrobial treatment, which of the following would be most appropriate?
- Amoxicillin-clavulanate
48. A 21-year-old female student presents at the university clinic with a nose bleed. This is her third bleeding episode in the past week she is otherwise healthy with no history of bleeding disorders. The NP advises that the appropriate first line intervention of anterior epistaxis is:
-Firm pressure to the area superior to the nasal alar cartilage
49. A 49-year-old woman presents with a three day history of Burning during urination, a thin and grayish white vaginal discharge in vagina itching. Laboratory examinations common you expect to find all-of the following except:
- pseudohyphae
50. You see a 77-year-old male for treatment in lacerations on his forearm. Upon examination, you notice poor skin turgor what it says on the arms and back of the hands. This is likely a sign of:
- normal age related change [Show Less]